Cornell Scott Hill Health Center, Ansonia, Connecticut.
Division of Chemical Dependency, Mount Sinai Beth Israel, New York City, New York.
J Opioid Manag. 2021 Jul-Aug;17(4):353-358. doi: 10.5055/jom.2021.0668.
Studies dating back to 1964 consistently support the effectiveness of methadone as a maintenance treatment for opioid use disorder (OUD), and since 2003, the effectiveness of buprenorphine. Short-term detoxification has not proven to be an effective treatment, as it results in high relapse rates when compared with maintenance treatment with an opioid agonist therapy (OAT). The question about the duration of maintenance treatment for OUD has been debated with recommendations ranging from a minimum of 1 year, 2 years, to indefinitely. Other factors such as misconceptions, regulations, and insurance barriers also have an impact on the duration dilemma of OAT.
There were no a priori criteria for article inclusion and this is not a structured literature review. It is a review of articles of convenience from 1964 to 2018.
This paper aims to address the dilemma of the ideal duration of OAT and to discuss the factors that could affect this decision.
Sustained OAT has had significantly better long-term outcomes than short-term detoxification or time limited maintenance. Optimal outcomes are dependent on adequate treatment duration.
Addiction is a chronic brain disease and its treatment should be similar to the treatment of other chronic medical and psychiatric diseases. Long-term, sometimes lifetime, continuation of OAT for the treatment of OUD results in optimal outcomes when measuring morbidity and mortality. The accumulated evidence does not support any arbitrary limitation to the duration of OAT.
早在 1964 年，就有研究一致支持美沙酮作为治疗阿片类药物使用障碍（OUD）的维持治疗的有效性，自 2003 年以来，丁丙诺啡的有效性也得到了证实。与阿片类激动剂治疗（OAT）的维持治疗相比，短期戒毒治疗并未被证明是一种有效的治疗方法，因为它会导致较高的复发率。OUD 的维持治疗时间长短问题一直存在争议，建议的维持治疗时间从至少 1 年、2 年到无限期不等。其他因素，如误解、法规和保险障碍，也会对 OAT 的持续时间产生影响。
本文没有事先规定的纳入标准，也不是一篇结构化的文献综述。这是对 1964 年至 2018 年期间方便收集的文章的回顾。
本文旨在解决 OAT 理想持续时间的困境，并讨论可能影响这一决策的因素。
与短期戒毒或限时维持治疗相比，持续的 OAT 具有显著更好的长期效果。最佳效果取决于足够的治疗持续时间。
成瘾是一种慢性脑部疾病，其治疗方法应与其他慢性医学和精神疾病的治疗方法相似。长期、有时是终身的 OAT 持续治疗 OUD，在衡量发病率和死亡率时可带来最佳效果。现有证据并不支持对 OAT 的持续时间进行任何任意限制。
